title: The perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery.
abstract: OBJECTIVE
  To describe the perioperative management of patients with left ventricular assist devices (LVADs) who require general anesthesia while undergoing noncardiac surgery (NCS) at a single, large tertiary referral center.
  
  
  METHODS
  Electronic medical records from September 2, 2005, through May 31, 2012, were retrospectively reviewed to evaluate the perioperative management and outcomes in LVAD patients undergoing NCS. Patients were included only if they required a general anesthetic and had previously been discharged from the hospital after initial LVAD implantation.
  
  
  RESULTS
  Thirty-three patients with LVADs underwent general anesthesia for 67 noncardiac operations. The mean ± SD time from LVAD implantation to NCS was 317 ± 349 days. All but 1 patient had axial flow LVADs. Anticoagulation or antiplatelet agents were present within 7 days before NCS in 49 procedures (73%) and reversed in 32 of 49 (65%). No perioperative thrombotic complications related to anticoagulation or antiplatelet reversal were noted. Red blood cell, fresh frozen plasma, and platelet transfusions were administered during 10, 6, and 4 operations, respectively. The only intraoperative complication was surgical bleeding. Postoperative complications were present in 12 patients after NCS and were mainly composed of bleeding. Three patients died within 30 days of NCS, with the causes of death not attributed to NCS.
  
  
  CONCLUSIONS
  Patients with LVAD safely underwent NCS in a multidisciplinary setting that included preoperative optimization by cardiologists familiar with LVADs when feasible. Anticoagulation or antiplatelet agents were present preoperatively in most patients with LVADs and were safely reversed when necessary for NCS. The relatively high occurrence of postoperative bleeding is consistent with previous series.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN.
authors.forename: David W
authors.initials: DW
authors.lastname: Barbara
authors.forename: David R
authors.initials: DR
authors.lastname: Wetzel
authors.forename: Juan N
authors.initials: JN
authors.lastname: Pulido
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Pershing
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.forename: Scott P
authors.initials: SP
authors.lastname: Zietlow
authors.forename: David S
authors.initials: DS
authors.lastname: Morris
authors.forename: Barry A
authors.initials: BA
authors.lastname: Boilson
authors.forename: William J
authors.initials: WJ
authors.lastname: Mauermann
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000706:statistics & numerical data; D015984:Causality; D015897:Comorbidity; D005260:Female; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000628:therapy*